Disclaimer: The activities in this document are intended for example purposes only. The actual activities implemented as part of TB program 

evaluation should be identified by state or local TB program officials in collaboration with other stakeholders. The example provided here is not 

intended to be applied directly to any specific TB program.

1

Program Evaluation Topic/Focus Area: Completion of Treatment for Tuberculosis Disease by 

Using Incentives and Enablers

Background 

The purpose of this section is to provide background, purpose or rationale, and intended use of your evaluation results. What are the 

expected outcomes and impact, if successful?

Background and Rationale

Scenario: In August 2020, a tuberculosis (TB) county public health program implemented activities that address barriers and improve 

TB completion of treatment (COT) within 12 months among patients receiving clinic-based, directly observed therapy (DOT). TB 

patients who receive DOT at home (or other locations) have high completion rates; therefore, the focus of this evaluation is on patients 

who come to the clinic for DOT. Activities included providing bus passes for TB patients so that they can get to the clinic for DOT, 

expanding clinic hours so that patients have more flexibility regarding when they must arrive for DOT, and rapidly following up to 

reschedule patients who miss a DOT visit. This process evaluation assesses the success of those activities.

Goal: Meet the 2025 National Performance Target (95%) of patients with newly diagnosed TB disease who complete treatment within 

12 months among those who are eligible to complete treatment within 12 months.

Objectives

Should be specific, measurable, attainable, realistic, and time-bound (SMART).

• By December 2021, decrease the percentage of TB patients with missed doses of in-clinic DOT from 10%/week to 5%/week.

• By December 2021, increase the overall percentage of TB patients who complete treatment from 86% to 90%.
Disclaimer: The activities in this document are intended for example purposes only. The actual activities implemented as part of TB program 

evaluation should be identified by state or local TB program officials in collaboration with other stakeholders. The example provided here is not 

intended to be applied directly to any specific TB program.

2

Corresponding National Tuberculosis Indicator Project Indicator

Program evaluation should ideally reflect the National Tuberculosis Indicator Project (NTIP). Please specify the NTIP indicator 

addressed by this evaluation. If the evaluation is not linked to an NTIP indicator, please provide an explanation regarding how the 

evaluation relates to your scope of work.

Corresponding NTIP indicator: Completion of Therapy – the proportion of patients who completed treatment within 12 months 

among those for whom ≤12 months of treatment was indicated.

Evaluation Plan Questions, Measures, Analysis, and Timeline for Treatment of Tuberculosis (TB)

Evaluation Question Measure Data Source Method of Analysis Target Timeline of Activities and Person

Responsible

Are bus passes, 

extended clinic hours, 

and follow-up 

telephone calls for 

missed directly 

observed therapy 

(DOT) effective ways 

to increase the 

number of patients 

who come to the 

clinic for DOT?

Proportion of patients 

who received bus 

passes

Number of patients 

who came to clinic 

during extended 

hours

Proportion of patients 

who rescheduled a 

same-day DOT when 

the scheduled DOT 

time is missed

Bus pass purchase 

receipts 

Patient selfreported use of bus 

passes

Clinic DOT logs 

and schedule

Number of patients 

who used a bus pass 

out of the number of 

patients who received 

a bus pass

Number of patients 

who came during 

extended hours

Number of patients 

who rescheduled 

same-day DOT out of 

the total number of 

patients who missed 

their scheduled DOT 

time

90% of patients who 

received bus passes 

arrive at clinic by 

scheduled DOT time

At least 5 

patients/week come

to the clinic during 

extended hours

90% of patients who 

miss their scheduled

DOT time are 

rescheduled

August 2020–December 2021

• DOT outreach workers will supply 

bus passes to eligible patients

• TB program manager will partner 

with sexually transmitted disease 

clinic to use their extra clinic hours 

for DOT patients

• DOT outreach workers attempt to 

reschedule missed DOT visit

• TB Program Evaluation Network 

(PEN) focal point and DOT outreach 

workers will develop and implement 

standard operating procedures for 

using incentives and enablers

• TB PEN focal point and DOT 

outreach workers will develop and 

implement standard operating 

procedures for follow-up on patients 

who miss their scheduled DOT time

January–August 2021
Disclaimer: The activities in this document are intended for example purposes only. The actual activities implemented as part of TB program 

evaluation should be identified by state or local TB program officials in collaboration with other stakeholders. The example provided here is not 

intended to be applied directly to any specific TB program.

3

Evaluation Findings and Conclusions

Updates to this section should be included as part of the annual progress report.

Indicate if this is a final report (i.e., the evaluation is complete) or an interim report (i.e., the evaluation is ongoing): This is a final 

report of our 2021 TB program evaluation activities. 

Evaluation Question and Related Findings

Benchmark

Met or Not Met

Are bus passes, extended clinic hours, and follow-up telephone calls for missed appointments effective ways to increase the number of patients who come to 

the clinic for DOT?

 • 9 of 12 (75%) patients who were given bus passes arrived at the clinic for DOT at their scheduled time. Goal 90% Not Met

• Epidemiologist and TB PEN focal 

point collect data weekly from clinic 

logs and bus pass records

• Data are assessed and shared with 

the TB program manager

• Areas not meeting the indicator are 

addressed (e.g., DOT worker not 

rescheduling same-day

appointments or patients not 

showing up during extended clinic 

hours)

Was the program 

able to increase 

completion of 

treatment among 

patients TB patients?

The proportion of TB 

patients eligible to 

complete treatment 

within 12 months who 

truly completed it 

within 12 months

National 

Tuberculosis 

Indicator Project

(NTIP)

Local surveillance 

system data

Number of patients 

who completed 

treatment out of the 

number of patients 

eligible to complete 

treatment within 12 

months

By December 2021, 

90% of eligible 

patients complete 

treatment within 12 

months

January–December 2021

• Status of indicator is assessed 

during monthly meeting with clinic 

staff, TB program manager, 

epidemiologists, and PE focal points

• Epidemiologist and PE focal points

review, monitor, and present NTIP 

data related to each indicator

• Clinic staff present successes and 

challenges in completing treatment 

among TB patients
Disclaimer: The activities in this document are intended for example purposes only. The actual activities implemented as part of TB program 

evaluation should be identified by state or local TB program officials in collaboration with other stakeholders. The example provided here is not 

intended to be applied directly to any specific TB program.

4

Evaluation Question and Related Findings

Benchmark

Met or Not Met

 • 5 of 5 patients (100%) who expressed the need for extended clinic hours arrived at the clinic for DOT during extended

 hours; 6 additional patients who had not previously expressed this concern also used extended clinic hours for DOT.

Goal 95% Met

 • 7 of 8 (88%) patients who missed DOT visits at the clinic were rescheduled by DOT workers the same day, and 1 (12%)

 patient who did not answer the telephone was not rescheduled and treatment will be extended accordingly.

Goal 90% Not Met

Was the program able to increase completion of treatment among TB patients?

 • Although we did not reach the 2025 target of 95% completion of treatment within 12 months for eligible patients, the 

 proportion who completed treatment increased from 86% to 90% in 2021 (among patients who could have completed 

 treatment during the year of the evaluation).

Goal 90% Met

Program Facilitators

What helped facilitate completion of this evaluation?

• Optimal relationship with sexually transmitted disease (STD) clinic.

• Flexibility in rescheduling appointments and multiple contact numbers for patients (in case one number did not work).

• Weekly and monthly data review and follow-up from epidemiologist, program evaluation staff, and the TB program manager.

• Financial support from the state health department for incentives and enablers.

Program Challenges

What major challenges did you face during this evaluation? If you did not meet your benchmark, please explain why.

• Extracting information from clinic logs was time consuming and it was difficult to find information.

• Although we knew how many bus passes were provided and to whom they were provided, there was no way to track how many 

bus passes were actually used (sometimes the DOT worker did not ask the patient if they used a bus pass that was provided by the 

clinic).

• Difficulty remembering to follow up with patients (DOT worker), no patient contact information, and patient not answering the 

telephone or being unreachable.

• DOT workers are already busy, and it took a lot of time to do follow up for missed appointments.

• Long-term use of free bus passes will be difficult due to the expense and lack of resources.

Use of Findings
Disclaimer: The activities in this document are intended for example purposes only. The actual activities implemented as part of TB program 

evaluation should be identified by state or local TB program officials in collaboration with other stakeholders. The example provided here is not 

intended to be applied directly to any specific TB program.

5

How did you use the findings from this program evaluation?

Findings from this evaluation were used to

• Negotiate with STD clinic manager to increase extended STD clinic hours for DOT patients. Cross-trained volunteer STD 

outreach workers to perform and record DOT.

• Provide training to DOT workers regarding using an appointment log or patient checklist to keep track of appointments.

• Brainstorm ways to help remind DOT workers when a patient is >30 minutes late or does not appear (e.g., put reminders on 

telephone calendar or cell phone alarm or check appointment log every hour).

• Justify cost of bus passes to help patients arrive at the clinic for DOT and alternative schedules for DOT workers who participate 

in extended STD clinic hours.

Deliverables, Products, and Dissemination Plan

Please provide a list of final deliverables and describe how you plan to disseminate to stakeholders.

• Share information during staff meetings, budget meetings, and cohort review meetings.

• Sustain line item for bus passes in each annual budget.

• Check-in quarterly with STD clinic manager to discuss any problems related to shared clinic hours.

• Adjust DOT worker schedules to accommodate extra clinic hours.

• Add contact sheet for missed or late appointments and reschedules to electronic scheduling system.

• Revise the standard operating procedures for use of incentives and enablers and follow-up for missed appointments based on 

lessons learned during the evaluation period.